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Suggest remedy for persistent Aspergillosis niger infection in left ear

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Posted on Thu, 19 May 2016
Question: Hi, I have aspergillosis niger in my left ear which is not clearing up on Sporanox so I've been put onto voriconazole today.
It started 15th Feb and was treated as a middle ear infection with Amoxil. On 19th Feb I was moved onto Augmentin Duo and Prednisolone. 22nd Feb back to doctor and she did a swab suspecting fungus. On 23rd Feb I went to emergency at hospital after 4 days of terrible pain. 25th Feb saw an ENT specialist who confirmed the aspergillosis and suctioned the ear giving some relief and started Sporanox 4 capsules per day (2x2). He said I had 2-3 holes in my ear drum so drops could not be administered due to pain. But a few days later I went back for more suctioning due to the pain returning. Again got relief. Today 10th March after 9 days I've seen the ENT today for suctioning again and the fungus is still there and now my ear drum is gone, completely eaten away. A fair bit of fluid in there too but it doesn't leak out at all. So he's started me on voriconazole twice a day.
Will this work? How long to clear up?
Also will the fungus spread through the ear canal to my brain or lungs and how would I know if that was happening? I'm totally deaf in that ear due to the ear drum hole which he said he could repair after the fungus has gone.
Any advice? I'm keeping my ear dry at all times. This is really impacting my quality of life!
doctor
Answered by Dr. Hariom Sharma (3 hours later)
Brief Answer:
With medication, it is unlikely to spread to the brain or lungs.

Detailed Answer:
Hi Ma'am,

I have gone through your question and understand your worry and concern.

I would like to reassure you that, the infection is unlikely to spread to your brain or lungs, this is because, you have been prescribed the appropriate anti-fungal medicines, your treatment now is going in the right direction.

However, for better and sooner results, I would like to suggest topical antifungal medication/ear drops in addition to the systemic medication your doctor has already prescribed you. You may request your ENT surgeon to prescribe you Clotrimazole 1% ear drops, the exact dosage and duration will be explained by your treating doctor.

With adequate treatment, the infection in your ear will take about 15 days to clear up completely, it is essential that you follow the advice of your treating doctor and continue the medications till the infection is completely cleared.

I would also suggest cleaning the ear and suctioning of the ear daily under microscope by your ENT doctor. You will have to discuss these additional steps with your treating ENT surgeon.

In addition to these steps, I would also suggest you to get your blood sugar levels tested and check if your immune system is functioning properly by getting a complete blood count, and HIV screening.

I sincerely hope I have been able to answer your question to your satisfaction, however, if you have any doubts or further queries, I would be glad to help you.

Wishing you speedy recovery.

Regards.

Dr Hariom Sharma MS, XXXXXXX



Above answer was peer-reviewed by : Dr. Yogesh D
doctor
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Follow up: Dr. Hariom Sharma (20 hours later)
Thankyou for your reply!
Ive tried drops locacorten but they sting badly due to the hole in my ear drum.
Is this fungas usually recurring? I never want to experience it again!
I suggested my ENT clean the ear by suction more regularly but he didnt seem keen, im seeing him again in 6 days.
Ive had recent blood tests and all was fine (the hospital did them when i went in due to the pain).
Im curious as to why the pain has stopped now but when looking into the ear canal under microscope yesterday its still full of fungas. What exactly causes the pain? It was radiating down my neck and into my head at its peak only controlled by endone and panadiene fotre.
This is a horrible infection.
Now im getting a cold so my nose is congested and some yellow discharge is coming from my ear. Should i blow my nose? It feels strange because i feel the air going out of my damaged ear.
doctor
Answered by Dr. Hariom Sharma (4 hours later)
Brief Answer:
You should not blow your nose

Detailed Answer:
Hi Mam,
I have gone through your follow up question and understand your concern.

I would suggest plain anti-fungal ear drop instead the locacorten i.e. combination of the anti-fungal and steroid.

This will not recur if treated properly.

Pain in your ear may be due to the acute otitis media of the ear that causes stretching of the ear drum and it subsides after the perforation in the ear drum which is what has happened in your case.

You should not blow your nose because your ear drum is already perforated and it may worsen your condition.

Regards
Dr Hariom Sharma MS, XXXXXXX


Above answer was peer-reviewed by : Dr. Yogesh D
doctor
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Follow up: Dr. Hariom Sharma (18 hours later)
How do i best deal with this cold (sneezing, runny nose) if i cant blow my nose? I try to be as gentle as i can.
Also im fairly sure I'll need surgery to replace the ear drum, it cant grow back when its been eaten all the way to the sides can it?
Whats involved in this type of surgery and whats recovery like? How long off work etc?
doctor
Answered by Dr. Hariom Sharma (21 hours later)
Brief Answer:
You can blow your nose gently but without putting pressure over the ear.

Detailed Answer:
Hi Mam,
I have gone through your question and understand your concern.
You can blow your nose gently but without putting pressure over the ear.

This surgery involve repair of the tympanic membrane (ear drum) by various grafts such as temporalis fascia, fascia XXXXXXX conchal cartilage, perichondrium and septal cartilage etc. but I personally prefer conchal cartilage graft. About one week is necessary in this surgery.

I would suggest that you may go for the surgery only after when fungal infection of the ear clear up.

Regards
Dr Hariom Sharma MS, XXXXXXX

Above answer was peer-reviewed by : Dr. Yogesh D
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Dr. Hariom Sharma

ENT Specialist

Practicing since :2006

Answered : 1113 Questions

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Suggest remedy for persistent Aspergillosis niger infection in left ear

Brief Answer: With medication, it is unlikely to spread to the brain or lungs. Detailed Answer: Hi Ma'am, I have gone through your question and understand your worry and concern. I would like to reassure you that, the infection is unlikely to spread to your brain or lungs, this is because, you have been prescribed the appropriate anti-fungal medicines, your treatment now is going in the right direction. However, for better and sooner results, I would like to suggest topical antifungal medication/ear drops in addition to the systemic medication your doctor has already prescribed you. You may request your ENT surgeon to prescribe you Clotrimazole 1% ear drops, the exact dosage and duration will be explained by your treating doctor. With adequate treatment, the infection in your ear will take about 15 days to clear up completely, it is essential that you follow the advice of your treating doctor and continue the medications till the infection is completely cleared. I would also suggest cleaning the ear and suctioning of the ear daily under microscope by your ENT doctor. You will have to discuss these additional steps with your treating ENT surgeon. In addition to these steps, I would also suggest you to get your blood sugar levels tested and check if your immune system is functioning properly by getting a complete blood count, and HIV screening. I sincerely hope I have been able to answer your question to your satisfaction, however, if you have any doubts or further queries, I would be glad to help you. Wishing you speedy recovery. Regards. Dr Hariom Sharma MS, XXXXXXX